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Updated: Aug 5, 2026
04:40
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Lesion-Level Association Between Artificial Intelligence-Derived Coronary Calcium Volume and Plaque Vulnerability
Ruben G A van der Waerden1, Joske L van der Zande1, Jan-Quinten Mol2
1Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands; Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, the Netherlands.
JACC. Advances
|July 28, 2026
Summary
Heavily calcified plaques show fewer vulnerability features, suggesting a lower risk of acute events. Less calcified, lipid-rich plaques exhibit more vulnerability, potentially explaining higher event rates.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Biomedical Engineering
Background:
- Extensively calcified lesions are generally considered low risk for acute events.
- This low risk is potentially linked to the presence of less vulnerable plaques.
Purpose of the Study:
- To investigate the relationship between total calcification volume and plaque vulnerability.
- To assess plaque vulnerability features in relation to varying degrees of calcification.
Main Methods:
- Prospective observational study (PECTUS-obs) using intracoronary optical coherence tomography (OCT).
- Analysis of fractional flow reserve-negative nonculprit lesions in patients post-myocardial infarction.
- Utilized a core laboratory for plaque vulnerability assessment and an AI algorithm (OCT-AID) for automated calcium quantification.
Main Results:
- Nearly all lesions (96.3%) showed some calcification.
- Lower calcification quartiles (Q1-Q3) had higher prevalence of lipid-rich plaques, macrophage accumulation, and microvessels.
- Higher calcification quartiles (Q4) showed significantly fewer plaque vulnerability features compared to lower quartiles (P < 0.001).
Conclusions:
- Severely calcified nonculprit lesions exhibit reduced plaque vulnerability features.
- Less calcified, lipid-rich lesions demonstrate greater vulnerability.
- This finding may explain the lower acute event rates observed in heavily calcified lesions.
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